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04223 (MDF5)--------------------------- 4 042,3 P.O. BOX 1504 Building 78-071 Cobalt Drive78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner >rn Mailing BUILDING:'TYPE CONST OCC. GRP. Address 777 ss main st e r Suite io6 A.P. Number ��w'i9i�•��A�s City Zip Tel. " an4o 92686 714-547-8036 Legal Description Contractor Project Description - Address 17e Plan 2 Address 4.. City Zip Tel. State Lic. City & Classif. 462814 Lic. # S Ft. 912 No. No. Dw. ' Size Stories Units " Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Garage included City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business ands Professions Code, and my license is in full force and f effect. - i i'i'i L ! 1,f '..NATURE DATE OWNER -BUILDER DECLARATION I hereby affirm'that I am exempt from the Contractor's License Law for the following Estimated Valuation A� reason: (Sec.. 703 1.5, Business and Professions Code: Any city or county which requires a a permit to construct; alter, Improve, demolish, or repair any structure, prior to Its Issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.-\ •`� t. et `f+ d �. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 3' 31. .00 Professions Code: The Contractor's License Law does not apply to an owner of property who t f�titt�, builds or Improves thereon and who does such work himself or through his own employees, Mech. provided that such improvements are not intended or offered for sale. If, however, the building ,psf ` or improvement is sold within one year of completion, the owner -builder will have the burden Electrical t\� ` + \ 44 .76 of proving that he did not build or improve for the purpose of sale.) t1 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing `�� .00 struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law .. A does not apply to an owner of property who builds or Improves thereon, and who contracts for S.M.I. 4 e.,7L, 9 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) _ Grading ❑ 1 am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Date owner Infrastructure A 444)//057 WORKERS' COMPENSATION DECLARATION erimeTood Lizard 30.18 I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of r Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company �— -- 2 ❑Copy is filed with the city. O Certified copy is Hereby`furnished. TOTAL �i'1 ♦ 272 ii s 7 r�� , �,� �7r-•3 , � 1 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed If the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback'.from'Center One**' -'^ Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to / expiration if work thereunder is suspended for 180 days. 1 certify that I have read this application and state that the above Information is correct. Issued by: Date Permit I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, Slate, Zip WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD • ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. .,ELECTRICAL FEES -k NO. PLUMBING FEES p UNDERGROUND A.C. UNIT COLL. AREA IST FL SO FT IQ S UNITS OUGH PLUMB BONDING HEATING (ROUGH) YARD SPKLR SYSTEM 2ND FL SO FT. g SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK MOBILEHOME SVC. BAR SINK POR SO FT. a (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. la GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO FT. (pt WATER HEATER SERVICE WALL SO. FT. a ` DRINKING FOUNTAIN WATER SYSTEM URINAL SO. FT. raT _ $ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FRAMING- (� WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT . WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11A c SEWAGE DISPOSAL FINISH GRADING SO.FT.GAR rA 3/4c HOUSE SEWER FINAL INSPECTION GAS PIPING PERMIT FEE CERT. OCC. PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR -- _0 SETBACK fr. ff GROUND PLUMBING p UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE' ® OUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. 7 (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. ` BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus z$ _ $ LUMBER GR. FINAL INSP. FRAMING- (� FINAL INSP. ROOFING , REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND tali FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL